Market Position Statement 2019/2021 - Adult & Children's Social Care & Health Services - Durham County Council

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Market Position Statement 2019/2021 - Adult & Children's Social Care & Health Services - Durham County Council
Market Position Statement 2019/2021
Adult & Children’s Social Care & Health Services
Market Position Statement 2019/2021 - Adult & Children's Social Care & Health Services - Durham County Council
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Market Position Statement 2019/2021 - Adult & Children's Social Care & Health Services - Durham County Council
Market Position Statement 2019/2021
Adult & Children’s Social Care & Health Services

 			       Page No.

1.   Welcome to Durham County Council’s Market Position Statement
     a. What is the Market Position Statement for?
		   b. Key messages		                                                4

2.   Introduction
		   a. About County Durham		 5

3. National Developments and Local Context 		 6
		 a. National developments
		 b. Local context
		 c. Key messages from the JSNA		            7

4. Messages to the Whole Market 		            9

5.   Market Opportunities              		 10-12

6.   Working with Durham County Council 		                            13

7.   Messages for Providers of Care and Support to Adults		 14-17

8.   Messages for Providers of Care and Support to
     Children and Young People’s Services 		 18-22

9.   Messages for Providers of Public Health Services		               23

10. Messages for Providers of Housing Services		 24-25

11. Planned Procurements for 2019/20 and 2020/21		                    26

12. Abbreviations		                                                   27


Market Position Statement 2019/2021 - Adult & Children's Social Care & Health Services - Durham County Council
Welcome to Durham County Council’s
Market Position Statement
Hello and welcome to Durham County Council’s third Market Position Statement (MPS). This
document has been produced with input from a number of internal and external stakeholders
including service providers and sets out the direction of travel for Children’s and Adult Social Care,
Public Health and Housing during 2019/2021.

What is the Market Position Statement for?
The aim of the MPS is to bring together information and analysis about the local market so that
current and prospective providers understand the local context, what is likely to change and
where opportunities might arise in the future.
The MPS is for both existing and potential providers with the purpose of helping them to shape
their business plans to support the council’s vision for the future of local public health, social care
and housing markets. It will help providers to:
• Identify opportunities that they may tender for
• Develop their services to meet local need and demand
This MPS is designed as an interim document, to be used until the development of an Integrated
Health and Social Care Market Position Statement for County Durham is finalised (see Section 7 –
Messages for providers of Care and Support to adults – for more information).

Key messages for providers
Services in County Durham in the future should:
    Be preventative so that people can regain independence and move away from support or on to
    less intensive support.
•   Be delivered in a more integrated way, with priorities aligned to improved service delivery and
    outcomes across the health and social care system.
•   Encourage personal and community resilience.
•   Offer short term interventions where appropriate.
•   Be flexible and person centred and developed with input from service users and carers.
•   Be designed and implemented around individuals and their communities.
•   Identify and achieve outcomes for service users and carers.
•   Be developed in partnership with the council and other commissioners and providers of
    service; for example health and the voluntary community sector.

                              I hope that you find this document accessible and useful. We plan
                              to refresh the ‘Planned procurements’ section on page 26 on a
                              quarterly basis to ensure that providers are as up to date as they
                              can be about future developments.
                              Denise Elliott
                              Interim HeadOpportunities
                                             of Commissioning

Market Position Statement 2019/2021 - Adult & Children's Social Care & Health Services - Durham County Council
2. Introduction
About County Durham                                                              0.5%
County Durham is a socially, economically and                                        Increase
physically diverse area, home to over 0.5m
people in 12 main towns with over 300 smaller
settlements, many of which are former colliery                            Total population of County
villages. The county plays an important                                  Durham in 2016, an increase
role in the economic success and stability                                of 2,400 people from 2015
of the North East, with key transport links

(A1M) and the East Coast main line railway
running through it, providing infrastructure
vital to local employment and the regional
                                                            Projected increase
economy. Around 90% of the population lives
in the east of the county, predominately the
former Durham coalfield. The more sparsely
populated western dales form part of the                   Projected population in
North Pennines Area of Outstanding Natural                 County Durham by 2041
Beauty.                                                       (5.6% from 2016)

Our population is changing, meaning
that County Durham will see significant
demographic changes in the future. By 2030,                                 Projected increase
the number of children and young people
aged 0-17 is projected to increase by 0.7%
(from 2016), reversing some of the declining
trends seen prior to 2011. The number of                                    Projected increase in
people aged over 65 is projected to increase                                 0-17 year olds by 2041
from almost one in five people in 2016 (20.2%)                     3.9
to over one in four people (27.0%) by 2030.
Predictions are for a fairly stable population
trend for people with learning disabilities
                                                          Projected decrease
with a level of need requiring statutory social
                                                      of 18-64 year olds by 2041
care interventions. Whereas the number of
people with a physical disability aged between
18-64 years is expected to increase overall
by approximately 500 people by 2020. The                                  Projected increase
number of people with a mental health need                                 of 65+ year olds by 2041
is not expected to change significantly.


                                                          Projected increase
                                                          of 85+ year olds by 2041

                                          Opportunities            %

Market Position Statement 2019/2021 - Adult & Children's Social Care & Health Services - Durham County Council
3. National developments and local context
For national developments and local context            Joint Strategic Needs Assessment (JSNA)
see the links below:                                   The JSNA helps the council and the CCGs
                                                       inform the planning and improvement of local
 National developments                                 services and guides us to make the best use of
                                                       the funding in the commissioning of services
 Care Act 2014
                                                       in County Durham.
 Children and Families Act 2014
                                                       County Durham’s JSNA is not just about
 Prevention concordat for better mental                health and social care, but reflects the many
 health - GOV.UK                                       factors that can influence people’s health and
 NHS five year forward view                            wellbeing. Locally it has provided the evidence
 NHS 10 Year Plan (awaiting publication)               base for the Joint Health and Wellbeing
                                                       Strategy (JHWS) and has informed the
                                                       development of the key strategies and plans,
 Local Context                                         including the Sustainable Community Strategy
 County Durham Joint Strategic Needs                   and the Children, Young People and Families
 Assessment - Durham County Council                    Plan.
 Integrated Needs Assessment consultation
                                                       Durham Insight
 - Durham County Council
                                                       Durham insight is a shared intelligence,
 County Durham Joint Health and Wellbeing              research and knowledge base for County
 Strategy - Durham County Council                      Durham, informing strategic planning across
 Sustainable Community Strategy - Durham               Durham County Council and its partners. The
 County Council                                        aim is to provide users with an easy way to
                                                       access and share information, intelligence,
                                                       research and knowledge for deeper insights
                                                       about their local area or communities. This
                                                       resource will be developed further over the
                                                       coming months.


Market Position Statement 2019/2021 - Adult & Children's Social Care & Health Services - Durham County Council
Key Messages from the JSNA

•		People in County Durham are living                   •		In addition to this, locally HLE is
   longer; life expectancy for both men (78.0              consistently below retirement age,
   years) and women (81.4 years) has been                  indicating levels of ill health among the
   improving over time, but the rate of this               working-age population and suggesting
   increase has slowed and there is still a                many residents are not able to enjoy their
   significant gap between the life expectancy             retirement in good health. If someone is
   (LE) in County Durham and the England                   diagnosed today with a long term health
   average.                                                condition at the age of 51 years there is still
                                                           on average 16 years of working life before
•		There is also a social gradient to LE within            state pension eligibility. The key point is
   County Durham, where men and women                      that, compared to England, not only do
   in the most deprived areas have a LE of                 people in County Durham live shorter lives,
   between 7 and 8 years shorter than the                  but also spend a smaller proportion of their
   least deprived areas.                                   life in good health and without disability.
•		It is also important to determine whether            •		14.5% of County Durham school children
   additional years of life are being spent                have Special Educational Needs and
   in good health or prolonged poor health                 Disabilities (SEND). That’s around 10,400
   and dependency. Healthy life expectancy                 young people in County Durham. This
   (HLE) adds a quality of life dimension to life          is similar to England but statistically
   expectancy. Similar to LE there is inequality           significantly lower than the North East.
   in healthy life expectancy between County
   Durham and England, and within County                •		Just over one fifth of the County’s
   Durham. Male and female HLE in County                   population is made up of people aged 65
   Durham is statistically significantly lower             and over.
   than England but has increased slowly over
   time.                                                •		Prevalence of long term conditions (such
                                                           as diabetes, coronary heart disease and
•		There is also a social gradient to HLE within           stroke) is significantly higher than the
   County Durham, where men and women                      England average.
   in the most deprived areas have a life
   expectancy of between 13.8 and 14.5 years            •		Estimates suggest that nearly 7,000 people
   shorter than the least deprived areas.                  in County Durham aged 65+ have dementia.
                                                           Projections suggest that this number
                               Men    Women                will rise to nearly 12,000 by 2035. As this
                                                           population will experience increasing levels
                                                           of morbidity this will present a significant
                                                           challenge to health and social care services.
                                                        •		Estimates suggest there are around 10,000
  Life expectancy                                          children with a diagnosable mental health
  (2014-16)                    78.1     81.4               condition in County Durham, that’s one in
  Healthy life expectancy                                  ten people.
  (2014-16)                    59.1     56.7
  Years in poor health         19.0     24.7


Market Position Statement 2019/2021 - Adult & Children's Social Care & Health Services - Durham County Council
•		Estimates suggest that 1 in 4 adults will
   experience mental health problems at any
   one time (25%). For County Durham, this
   represents over 100,000 people aged 18+.

•		Durham has a higher rate of older people
   admitted to permanent residential/nursing
   care (762.7per 100,000 population) than
   England (610.7 per 100,000 population).

•		Evidence suggests that people are being
   admitted to permanent residential care
   later in life (average age 87 in 2017/18).
   Length of stay seems to be decreasing (598
   days in 2017/18 compared to 637 days in
  Average Length of Stay
  700      637       631                                                 609                        629
                                                                                  579                          598
  600                           528       547                   521                       549
  500                                                                                            417
                                                                                352     374
  400    324                                                                                                 320
                   273        280                             257     271
  300                                            235
        2007/08 2008/09 2009/10 2010/11 2011/12 2012/13 2013/14 2014/15 2015/16 2016/17 2017/18

               Average                Average                 Linear (Average            Linear (Average
               nursing days           residential days        nursing days)              residential days)

•		In County Durham there were over 2,330
   emergency admissions for falls for those
   aged over 65 in 2016/17. This is statistically
   significantly higher than England. Falls are
   the largest cause of emergency hospital
   admissions for older people, and have a
   significant impact on long term outcomes
   e.g. being a major factor of people moving
   from their own home to long-term nursing
   or residential care.
•		Estimates suggest that 20% of the older
   population are mildly lonely and a further
   11% are intensely lonely. For County
   Durham this would mean around 19,000
   people aged 65+ are lonely and over 10,000
   experiencing intense loneliness.
•		There are approximately 59,000 adult
   carers in County Durham. The number of
   carers aged 65+ providing unpaid care isOpportunities
   to increase by 27.9% by 2030.

Market Position Statement 2019/2021 - Adult & Children's Social Care & Health Services - Durham County Council
4. Messages to the Whole Market
Finance and funding                                     Integration
In 2017/18 the council spent over £145 million          Social care and health organisations across
on adult social care and over £11.5 million on          Durham have agreed to an ambitious plan to
children’s social care in both the independent          further integrate services in the future. Revised
sector and voluntary and community sector.              management structures are being established
This figure excludes direct payments, where the         and a dedicated Provider Alliance group will
expenditure in this area for 2017/18 was over           ensure that provider issues and market factors
£11 million for adults and over £350,000 for            are considered throughout the social care and
children. Over £28m has been spent on Public            health system.
Health and £15 million on housing related
services in 2017/18.                                    Providers should be aware that partner
                                                        organisations will continue to seek opportunities
The council’s Commissioning Service continue            to jointly commission services in the future,
to achieve significant savings through service          reducing duplication of work and allowing
remodelling; negotiation with existing providers;       providers more opportunity to deliver services
and some decommissioning and, where                     across the whole market. Service users should
appropriate, reinvestment in more efficient             not experience different approaches to services
services to better fit future needs.                    because they are being commissioned by
                                                        different organisations and this integrated
The latest Medium Term Financial Plan (MTFP)            approach will ensure that resources in Durham
information shows that Durham County Council            are delivered in the most efficient, cost effective
will have made £224m savings to 31 March                way.
2019, with a further c£35m of savings between
2019/20 and 2022/23.                                    Please see Section 7 – Messages for Providers
                                                        of Care and Support to Adults – for more
Continued support for a wide range of                   information.
preventative services and a transformation
approach in front line children’s services and          Supporting the provider market
adult care are helping to ensure that the               Durham County Council intends to deliver a
Council’s higher cost social care resources are         programme of work in the coming years to
targeted at those most in need.                         enhance, maintain and support workforce
This approach will continue with the council            training, recruitment, retention and development
seeking further opportunities to commission             in a number of adult service sectors across
services more efficiently whilst improving              provider markets, such as domiciliary/
quality standards and an increased front line           community-based care, residential /nursing care,
focus on the development of local community             day services and the voluntary sector.
resources, alternatives to traditional resources        This work will be funded through the Improved
and supporting the growth of the current                Better Care Fund (IBCF) and providers and
reablement, rehabilitation and recovery                 their priorities will be a key consideration in
approach.                                               planning the programme. This supporting
The council is committed to stimulating a               the provider market initiative is designed to
diverse market, where innovation and more               be transformative, with an emphasis on new
efficient and effective ways of working are             ways of working; including utilisation of new
encouraged and inadequate practice is                   technology to support improvement.
addressed. We will therefore continue to involve     Early examples of interventions linked to this
and engage existing and potential providers          work, such as falls training/increased emphasis
and stakeholders to ensure we look for different     on falls response; brokerage; and additional
approaches to meet diverse and developingOpportunities
                                                     reablement resources, are already benefitting
needs.                                               service users, providers and health and social
                                                        care systems across Durham.
Market Position Statement 2019/2021 - Adult & Children's Social Care & Health Services - Durham County Council
5. Market Opportunities
The following suggestions are ways providers            arranged a Virtual Budget for the individual,
can improve the quality of the services they            which he then used to attend bespoke music
deliver:                                                sessions where he was taught how to create
                                                        and record his own music. This tied in with his
Working with stakeholders - Involve relevant            interests and achieved his identified care plan
council staff, service users and their carers/          outcomes of increasing self-confidence and
family in the design and development of any             skills for future employment/volunteering.
services, their feedback is key to improving the
quality of services. Providers need to consider         Focus on workforce development –
how feedback can be applied practically to              Appropriately trained, qualified and
develop new or improve existing services.               competent staff who are well supervised and
                                                        managed improves the quality of service
Monitor and review performance –                        delivered. We have offered Falls Training to
Tracking performance and auditing of key                44 care homes during September – November
areas of service delivery ensures areas                 2018, based on those with the highest
for improvement can be identified. This                 incidence of emergency call-outs (falls being
helps to improve quality, identifying best              the major contributor to these). A pilot on
practice and benchmarking with others                   Sepsis Training is also being undertaken with
ensures learning can be applied, leading                36 staff working in Extra Care, domiciliary care
to service improvement. Clear standards,                and Reablement during October 2018 and
consistency and compliance to service                   if successful, will be rolled out to the wider
delivery expectations ensures quality                   provider market in early 2019.
assurance. A cycle of plan-do-check-act
ensures improvement is monitored and can be             Durham Dales Easington and Sedgefield
demonstrated.                                           Clinical Commissiong Group are also
                                                        implementing infection control training with
Review marketing tools used – providers can             domiciliary care providers. An update has
promote their service in the most effective             been delivered at the Domiciliary Care Forum
places (e.g. Locate which is County Durham’s            and arrangements are being made for further
‘emarket place’               sessions in the County, with key provider
Consider whether information provided to                staff being trained so that they can cascade
people regarding services is accessible and             learning to their individual organisations.
easy to understand.

Improving outcomes for people - as
part of the increased focus on quality for
service users, there is a new emphasis by
commissioners in ensuring good quality
outcomes for people. We are looking for
providers who can deliver innovative, flexible
person centred services and, from a broader
point of view, we will expect good providers to
recognise that the people using their services
and their carers are experts in their own lives
and are therefore essential partners in the
design and development of services.
As an example of this new approach, the
council recently assessed a service user Opportunities

with a learning disability who was clear that
he didn’t want to access a day service. We

Quality Assurance – The Safeguarding                   Person centred approach
Practice Development Team, commissioners,              We want all our services to treat each person
Infection Prevention and Control (IPC) nurses          according to their individual care and support
and Care Quality Commission (CQC) work                 needs and preferences. It is important that
closely together and with providers, having            providers adapt their service to deliver flexible
regular information sharing meetings to                options and tailored support, particularly as
discuss the quality of locally registered              more and more people will be making their
services, agree ways to improve this where             own choices in purchasing care utilising their
required and plan how to respond to                    Personal Budgets and Direct Payments, or as
developing problems.                                   self-funders.
The council’s Commissioning Service will               A person centred approach to care and
continue to monitor contracted providers               support, will support people to:
to assess the quality of service provision
using relevant evidence-based measures                 •		live independent lives in the way they have
and to ensure contractual compliance. We                  chosen, based on information about the
will continue to further develop effective                options available, and as much involvement
processes for ensuring the quality of services,           as they want in decisions about what care
whether or not they are registered with CQC.              and support they need and how it should be
We will ensure that Locate continues to                   delivered.
indicate where a service is CQC registered or          •		maintain relationships with family and
accredited with the council to help service               friends and provide opportunities to take
users make informed choices when they                     part in community life, including engaging
are choosing a care home or other service,                in activities which match their interests,
funding their own care or in receipt of Direct            skills and abilities.
                                                       •		live without fear of harm or abuse and
                                                          support them to manage any risks which
                                                          might arise and to avoid unnecessary risks.
                                                       •		experience the provision of care positively,
                                                          through relationships based on mutual
                                                          respect and consideration, and where
                                                          care - designed around their needs - is
                                                          both consistently delivered and well co-
                                                          ordinated with other agencies.
Service user contributions to costs of services         There is no reason in principle why these
All Councils who have decided to charge for             elements cannot apply to all groups of people
services must follow regulations issued by the          needing care and support regardless of the
government. Within County Durham, those                 setting in which they live, be it a care home,
people who are assessed as being eligible for           sheltered housing or their own home. Indeed
social care services may be expected to make            it is important that such elements are present
a financial contribution towards the cost of            for all people in all circumstances. That is the
those services depending on their financial             essence of personalisation – tailoring care
circumstances. Please refer to the council              and support to what individuals choose as a
website for further information Paying for your         means of helping them to live their normal
care and support - Durham County Council                life. People don’t want to be defined by
Not all services are currently chargeable, for          their condition – they are not suffering from
example intermediate care, advocacy services            dementia or autistic or subject to multiple
and some carer support services. Charging               co-morbidities. They are, first and foremost,
                                               Market individuals with very personal hopes, fears,
implications for services will be communicated
to the people who will access them and the              aspirations and relationships.
providers that will deliver them.
Self-funders                                          Voluntary and Community Sector Enterprise
The council expects the number of self-               (VCSE)
funders seeking care to increase in the future        The council will continue to signpost a number
and has planned for more individuals seeking          of people to services in the community
our advice as a result of the Care Act 2014,          and an assessment will be made about the
which outlines updated responsibilities for           scope and ability of small and medium VCSE
such individuals. The council has a duty to           providers to meet this requirement. The role
support those people who choose to fund               of the VCSE in combating social inclusion is
some or all of their care and support and             increasingly important and VCSE providers
who need non-residential services. In limited         across the county will be encouraged to work
circumstances, the council may also choose            responsively in their local communities.
to exercise its discretion under the Care Act
to arrange care for self-funders who need             VCSE organisations play a key role in the
residential or nursing care.                          delivery of services, particularly at a time of
                                                      major change for the public sector and are
We will continue to develop information and           well placed to take advantage of opportunities
improve support and advice on the options             and identify new ways of working. The sector
available to self-funders, including potential        can become a delivery agent that will ensure
brokerage services. The council also continues        the sustainability of vital services across the
to improve and extend its online Locate               county by taking a proactive approach. The
adult care information service, which is an           council will seek to evolve and strengthen
important tool for self-funders looking for           our ethos of partnership working with VSCE
guidance on care services in the County.              providers.
                                                      Our VCSE Strategy identifies that knowledge
                                                      has improved, understanding increased
                                                      and productive working relationships have
                                                      developed. All partners recognise that a
                                                      strong, active and flourishing VCSE is a vital
                                                      component in building resilient communities
                                                      and enabling individuals to reach their


6. Working with Durham County Council
Corporate procurement                                  Social value
As a contracting authority the council must            The council are fully committed to wider social
adhere to procurement legislation in the form          benefits and the environmental wellbeing of
of the Public Contracts Regulations 2015.              County Durham and fully embrace the duties
Within this legislation, and relevant to social        set out in the Public Services (Social Value) Act
care and health services, are rules that allow         2012.
flexibility in procurement for certain service
contracts in social care, health and education         In 2013 Durham was the first local authority
- they allow a Light Touch Regime (LTR) to             in the North East to establish its Social Value
be applied to the procurement process. This            Task Force. In 2016 the council was a winner
allows us to tailor the procurement to take            of the Social Value Leadership Award, and we
into account additional criteria such as the           continue to be a committed member of the
market and its development, specific needs             National Social Value Task Force.
of the client group, and the involvement and           We have applied our social value duties
empowerment of service users.                          in a wider context than the Act requires,
Further information on how to do business              by contributing to the work of the Local
with the council is available:                         Government Association (LGA), and as
                                                       a contributor to the Social Value Portal
Support in using the NEPO ProContract portal           in developing a national model for
and more information on public procurement             implementation of social value through
legislation (Public Contract Regulations 2015)         procurement. This national model considers
is available from corporate.procurement@               opportunities for social value in the design of                                          the procurement process, the specification,
                                                       specific clauses, or by the way the evaluation
Information on the procurement process and             criteria is applied. An example of this is the
tips for completing a bid, as well as details          most recent domiciliary care procurement
of supplier engagement events for large                which appointed the majority of providers
procurements, see                         from Durham/North East region. This
                                                       promoted local economy, business sector
                                                       employment through Careers in Care. The
                                                       project manager for Supporting the Provider
                                                       Market will work with providers to enhance
                                                       recruitment/retention and skills in the coming
                                                       The council will continue to promote and
                                                       embrace the requirements of the Public
                                                       Services (Social Value) Act 2012 by pursuing
                                                       improvements to Durham’s economic, social
                                                       and environmental wellbeing, which are
                                                       recognised as the three pillars of sustainable


7. Messages for providers of care and support to
 The work of DCC Commissioning in relation            Teams Around Patients (TAPs)
 to adult care and support services will focus        This model acknowledges that more care
 on a number of key areas:                            should be delivered in community settings
                                                      and at home, through better integration of
Integration of health and social Care                 provision by a range of staff delivering care
Integration has been a key policy driver for          which supports those patients who are most
many years within health and social care.             vulnerable and are at risk of deterioration of
Most recently the Five-Year Forward View and          their health and wellbeing. The TAPs model
the Care Act 2014 outlined the need to design         has an increased focus on prevention and
and implement services around individuals             promoting independence by coordinating care
and their communities, to further enhance             across the whole range of a person’s health
pathways and joint service provision across           and care needs.
health and social care.
                                                      TAPs are operational across County Durham,
The NHS locally have already began to                 principal outcomes include reducing
integrate their commissioning and delivery            avoidable hospital admissions, improved
functions, for example the five Clinical              out of hospital services, less presentation
Commissioning Groups across Durham,                   at Accident and Emergency departments,
Darlington and Teesside have a unique                 improving rehabilitation and Reablement
partnership with Tees Esk and Wear Valley             services, reducing the need for permanent
NHS Trust called the Accountable Care                 residential or nursing care home placements
Partnership, which focuses on integrated              and connecting and supporting people better
NHS commissioning in relation to learning             in their own communities.
disabilities and mental health.
                                                      Joint Strategic Commissioning Function
This way of NHS integrated working makes best         An agreement has been reached in principle
use of resources, of the skills and expertise         that exploring a Joint Strategic Commissioning
of staff and allows any savings made to be            Function would benefit County Durham. This
reinvested into front line patient care.              could potentially include the commissioning
                                                      of community based services for children
                                                      and adults across the County. Acute (hospital
                                                      based) and other health care commissioning
                                                      is expected to be delivered outside of this
                                                      model and would be addressed by CCGs at a
                                                      regional/sub-regional level.
                                                       An Integrated Care Board (ICB) will be
                                                       responsible for driving service development
                                                       with partners to ensure that system
                                                       integration happens effectively. The ICB will
                                                       be a key decision making authority for the
                                                       new strategic model of care. Membership will
                                                       include leaders from all organisations in the
                                                       local health and social care system and the
                                                       ICB will act as a forum where whole-system
                                                       challenges can be addressed and solutions
                                                       identified and initiated. The board will play a
                                                       crucial role in the success of new, integrated

models of care, enabling swift and decisive            The commissioning strategy will need to
leadership across multiple organisations,              take into account wider work that is being
including both providers and commissioners.            undertaken regionally with other local
                                                       authorities, CCGs and NHS England as well
Prevention                                             as local partnerships between health, social
We will continue the work with stakeholders            care, education, employers, housing, the
on reviewing preventative services to reduce           Voluntary and Community sector, police and
or delay the need for statutory care and               the Criminal Justice System.
support in order to make social and health
care services more sustainable in the future.          The following key principles have been
This aligns with the feedback that we have             developed for strategy implementation:
received from individuals about wanting to             Co-production - through appropriate service
remain in their own homes for longer.                  user, carer and provider representatives/
Learning Disability Services
In 2018/19 the council is developing a Joint           •		Taking a whole-life approach including
Commissioning Strategy for adults and young               young people in transition
people (14-25) with learning disabilities, in          •		A focus on early help, timely intervention
collaboration with health colleagues. This will           and prevention
outline our commitment to supporting people
with learning disabilities and helping them            •		Promoting personalisation and progression
maximise their independence, choice and                •		Improving outcomes such as increased
control. It will be underpinned by a strategic            independence and employment
action plan, which will guide commissioning,           •		Improving outcomes such as increased
planning and decision making processes.                   wellbeing, choice and control with shared
Partners will work with local stakeholders                responsibilities and community resilience
to agree a shared vision and commissioning
priorities for the future.                             •		Delivering a coordinated approach to
                                                          supporting individuals to achieve their goals
Joint commissioning between the CCGs and
the council will be strengthened through               •		Promoting and developing provider
the best use of resources; more integrated                resilience and responsiveness to local
commissioning, contracting, monitoring                    needs
and reviewing arrangements; and working                •		Increasing efficiency, cost-effectiveness
together better with service users, carers and            and value for money
providers to develop and manage the market.
                                                       •		Ensuring services are safe and of high quality


Autism                                                In-house services
An autism action plan is under development            The council has recently reviewed and
in 2018/19 to support the implementation of           realigned our in-house, County Durham Care
the national Think Autism Strategy in County          & Support (CDCS) services. Supported Housing
Durham. A multi-agency Autism Strategy                and Reablement services previously provided
Implementation group led by the council is            by CDCS will be delivered by the independent
overseeing the action plan with involvement           sector in the future.
from key stakeholder representatives. Areas
that will be covered include preventative             The council continues to provide Extra Care
support, diagnosis and care pathways,                 services through CDCS at a range of locations
employment and housing; as well as support            across Durham. Pathways Day Services are
for young people in transitions, those with           strategically positioned to provide for more
complex needs or whose behaviour may                  complex, specialist service user groups with
challenge and people with autism in the               those who require less intensive services being
criminal justice system. The strategic action         placed in the independent sector via the Day
plan will help to identify commissioning              Services Panel.
intentions. Current priorities are meeting the        The Hawthorn House respite service is in the
Transforming Care agenda and developing               process of being reviewed and is likely to also
respite options.                                      accommodate more complex service user
                                                      groups in the future.
Mental health
A mental health strategic plan is being               The council is also seeking to expand its
developed by Public Health on behalf of the           Shared Lives offer, in recognition of the strong
Mental Health Strategic Partnership Board,            track record of these services in relation to
a multi-agency/stakeholder group, which               improving service user outcomes. The Mental
reports to the County Durham Health and               Health Support & Recovery service is also
Wellbeing Board. The five priority areas of           being retained in house, with consideration of
the strategic plan are Children and Young             the future direction of this service being taken
People’s Mental Health and Wellbeing,                 forward as part of the wider mental health
Adults Mental Health and Wellbeing,                   review work, as outlined above.
Suicide Prevention, Crisis Care Concordat
and Dementia. Commissioning plans for                 Carer Support
mental health will be developed as part of            The introduction of the Care Act 2014 has
the different workstreams. This will include          seen an increase in the number of carers
the council and partners continuing work              asking for support as carers now have a right
on the implementation of the mental                   to an assessment in their own right even if
health promotion, prevention and wellbeing            the person they care for does not have eligible
model, which will involve re-modelling and            needs. The council will continue to offer
recommissioning current provision.                    support to adult carers, including through its
                                                      contracts with carer organisations.
                                                      Similarly the Children and Families Act 2014
                                                      has clarified the law relating to young carers
                                                      ensuring the right to an assessment of needs
                                                      for support is extended to all young carers
                                                      under the age of 18 regardless of who they
                                                      care for, what type of care they provide and
                                                      how often they provide it.

                                                       Residential and nursing care
                                             Market The council continues to work with a range
                                                       of residential and nursing providers to deliver
                                                       both long and short-term support in care

home settings. This includes the Intermediate            efficiencies which can then support the wider
Care beds model in Durham, where the                     commissioning activity of social care and
council commissions both ‘step up’ and ‘step             health services.
down’ beds for reablement and rehabilitation
purposes for a maximum period of 6 weeks.                Information from the recent Adult Social Care
                                                         Survey 2017-18 highlighted that the majority
We will continue to engage with the care                 of service users (88.2%) said the service made
home market to address issues such as the                them feel more confident. Most service users
optimum model for nursing services, given the            (85.4%) said they were able to do more things
national pressures on the supply of nurses and           for themselves after their service ended. The
the potential outcomes from future changes               majority of service users (88.7%) said the
in government policy.                                    service helped them to have a better quality
                                                         of life. Of the service users that have used the
The council will also work on improving                  Reablement Service before 89.7% of them
analytical data in relation to the provision of          required no ongoing care or had a reduced
residential and nursing care, in recognition of          care package going forward.
the challenges faced by both Local Authorities
and providers in terms of predicting future              Comments such as “The service was a real
need and where and how resources should be               bonus for me to be able to remain in my own
directed.                                                home”, indicate that the service is working
Domiciliary care
A review of domiciliary care services will               Day care services
report in late 2018 and will be followed by              A provider panel for day care will be
a procurement process to re-commission                   commissioned on a yearly basis to allow new
domiciliary care services from 1st April                 providers to come onto the day care approved
2019. The review will consider if any                    framework. The Council intends to work with
strategic changes are required to the current            day services providers to increase innovation
domiciliary care framework and/or spot                   in these services, including identifying
commissioning arrangements.                              service users with aspirations to move into
                                                         volunteering or paid work in the future, in line
The council recognises the key role which                with transforming care principles.
domiciliary care plays in supporting people to
remain in their own home and assist hospital
discharge alongside wider health services.
The review will consider the optimum ways of
ensuring that domiciliary services are robust
in terms of their ability to deliver high quality
interventions in the future.

Reablement services
Reablement is a key community service which
plays a critical role in helping individuals to
recover and regain independence following,
for example, a stay in hospital.
The council has a dedicated, countywide,
Reablement service in place and as well as
seeking to increase the usage of this service,
will also explore the potential of using
reablement principles in the delivery of other
provisions, either existing or new. As well Market
as benefiting individuals in terms of their Opportunities
own wellbeing, Reablement also generates

8. Messages to providers for children’s services
 We want County Durham to be a great place           •		And achieve the best possible outcomes
 for children and young people to grow up               for children and young people with special
 in and for Durham to be a place where all              educational needs and disabilities (SEND)
 children are healthy, happy, and achieving
 their potential.                                    Commissioned providers play a key role
                                                     in helping us deliver these outcomes for
Our key aims are to ensure:                          individual children and young people.
•		Children and young people have a safe             Durham County Council remain committed
   childhood                                         to securing the participation of children and
•		Children and young people enjoy the best          their families to enable them to influence
   start in life, good health and emotional          decisions about their lives and the design and
   wellbeing                                         delivery of services that leads to change.
•		Children and young people can access              We believe that children and young people
   good quality education, training and local        that are looked after and/or children and
   employment                                        young people who have special educational
                                                     needs and disabilities have the right to the
                                                     same outcomes as every child in County
                                                     Durham to ensure that Durham is a place
                                                     where all children are healthy, happy, and
                                                     achieving their potential.
                                                     There are different degrees of participation
                                                     but where possible Durham County Council
                                                     and partners will strive to co-produce
                                                     services with children, young people and
                                                     their families.
                                                     Co-production is a way of working that
                                                     ensures people who use services are involved
                                                     in an equal partnership. Co-production places
                                                     an emphasis on engaging groups of people
                                                     at the earliest stages of service design,
                                                     development and evaluation. Co-production
                                                     acknowledges that people with lived
                                                     experience of a particular condition are often
                                                     best placed to advise on what support and
                                                     services will make a positive difference to
                                                     their lives. Done well, co-production helps to
                                                     ground discussions in reality and to maintain
                                                     a person-centered perspective.

For co-production to become part of the way we work, we will create a culture where the
following values and behaviours are the norm:

   Ownership,                            A commitment
                                                                                    A culture in
  understanding        A culture of        to sharing               Clear
                                                                                   which people
  and support of      openness and         power and          communication
                                            Market                                are valued and
  co-production          honesty         decisions
                                         Opportunitieswith    in plain English
      by all                                 citizens

Children and young people have a safe                    Children’s residential services
childhood                                                Durham’s agreed route to seek external
The council works collaboratively with                   residential provision for children is through
families and partners to offer family support            the new regional flexible solution called the
and enable children and young people to be               North East 12 Consortia Framework which
cared for within their own families wherever             commenced on the 1st February 2018. This
possible. We offer a range of Early Help                 enables the council to purchase children’s
Services to support children and their families,         residential home placements and for
and prevent entry into care.                             children and young people from independent
When it is not possible for a child or young
person to remain with their family, we will              An analysis of need highlights that there
seek to provide high quality care which meets            remains insufficient residential provision
their individual needs, as near as possible to           to meet the current and future needs
the child or young person’s home to maintain             of our looked after children and young
links with birth parents, relatives and their            people. Particularly in relation to children
communities (where appropriate).                         with complex needs and behaviour that
                                                         challenges who require solo provision to
Independent fostering                                    support discharge arrangements and bail
Alongside our own fostering and residential              conditions. There remains a pressing need
arrangements we make placements with                     to develop provision that has the capacity
independent fostering agencies (IFA’s) and               to provide a broader and more flexible
independent children’s residential homes                 and accessible range of quality residential
where this may be necessary to meet the                  solutions which ensures that the needs of our
child’s needs. Durham plays an active role               most challenging and complex children/young
in the current North East 7 IFA Consortia                people are met.
Framework, which enables independent foster
placements to be purchased from providers.               Care leavers
This is an established framework in its second           As Corporate Parents we want to give care
phase which has received positive feedback in            leavers every opportunity to be happy,
national reports.                                        healthy and safe and to achieve their full
                                                         potential. It is important that their transition
The current framework is due to end in March             into adulthood is positive and that all
2019. A new commissioning solution is                    young people have the necessary life-skills,
being developed involving 12 regional Local              confidence and experience to enable them
Authorities. It is anticipated that this regional        to thrive. Young people leaving care need
approach will result in greater understanding            somewhere safe and suitable to live to
and input into the recruitment strategies                help them make a positive transition into
of IFAs and a consistent approach to the                 adulthood. Good housing underpins success in
commissioning of IFA placements across                   other areas of life.
the region. The new solution will also offer a
greater level of flexibility, enabling new IFAs          The council has historically worked with the
to join (following relevant checks) throughout           provider market to develop a menu of options
the term of the contract.                                to meet the accommodation needs of care
                                                         leavers which are accessed on a spot purchase
                                                         basis. The introduction of new legislation in
                                                         April 2018 that requires Local Authorities to
                                                         secure support and accommodation for care
                                                         leavers up to the age of 25 will result in an
                                                         increase in the need for accommodation and
                                               Market support options for the 21-25 age group. An
                                                         analysis of need further highlights that there

                                                         is a growth in demand for supported living

more generally (16-25 years), with a need to            The 5-19 service
consider support and accommodation options              Provides a service to all children and young
for young people released from custodial                people of school age, and their families,
settings. In response, there will be a need to          whether or not they are attending school.
increase the number of accommodation and                The service offers advice and information,
support options for Care Leavers across the             and assesses the health needs on children
county.                                                 entering school and on transfer to secondary
                                                        schools. The service is the first point of contact
Children and young people enjoy the best                for schools when there are concerns about a
start in life, good health and emotional                child’s health and wellbeing.
We want every child to have the best start in           These services are scheduled to be
life and ensure that this continues throughout          recommissioned in early 2020. Going forward
their childhood through the promotion of                it is anticipated that there will be further
good health and emotional wellbeing. Healthy            emphasis placed on the integration of
and resilient children are ready to learn, ready        health, education and care services across
for school and have good life chances.                  communities to secure the best start in life,
                                                        good health and emotional wellbeing for
County Durham’s Healthy Child Programme                 children, young people and their families.
This initiative is a commissioned public
health programme for children, young                    Children’s mental health services
people and families which focuses on early              Mental health problems in children and
intervention and prevention. The service works          young people are common and account for
in community settings to deliver universal              a significant proportion of the burden of
and targeted interventions designed to                  ill-health in this age range, with estimates
meet public health outcomes to secure the               suggesting that mental health problems affect
emotional and physical health and wellbeing             approximately one in ten. Durham County
of babies, children, young people and                   Council and partners continue to consider
families across County Durham. The service              ways to make it easier for children and young
is delivered in partnership with a range of             people, their parents and carers to access help
health, social and education organisations.             and support when needed.

The 0-5 service                                         The council and the CCGs jointly commission
Offers a programme                                      a suite of preventative mental health services
of screening tests,                                     including:
immunisations,                                          •		Children and Young People’s Bereavement
developmental                                              Support Service which provides easily
reviews, information                                       accessible and culturally appropriate post
and guidance to                                            intervention and bereavement counselling
support parenting                                          and support for the children and young
and healthy lifestyle                                      people in County Durham.
choices. All families
with a child under five in County Durham                •		Suicide Prevention Helpline which provides
have access to the community-based service                 confidential practical advice and support
which consists of Health Visitors, Early                   to children and young people who are
Years and Assistant Practitioners and infant               experiencing suicidal thoughts and finding
feeding specialists. They provide expert                   life difficult; and also offers advice to
health assessments, advice, support and                    those who may be concerned about a
interventions for babies, children and families            young person who they feel may be having
and encourages and supports parents and                    thoughts of suicide.
carers to develop life-long skills to enable Market •		Parental Peer Support Service which
them to make informed choices that affect                  provides parent support groups in County
their family’s future health and wellbeing.                Durham, one in the South and one in

the North for parents with experience of             changing attitudes of individuals who have
  supporting a child with emotional and                perpetrated domestic abuse.
  mental health problems.
                                                       Children and young people can access
Existing contracts are due to expire in January        good quality education, training and local
2019 therefore, we are currently working to            employment
review a wide range of preventative Mental             All pupils should be helped and encouraged
Health services with procurement scheduled             to achieve or exceed the standards of a good
to commence November 2018 with new                     education. To support learners who, because
services in place from February 2019. In               of exclusion, illness or other reasons, would
addition, we are currently engaging with               not otherwise receive suitable education,
Children and Young People with a view to               schools have the power to secure alternative
developing a “Digital Offer” aimed at early            education that is tailored to the young
intervention of Mental Health issues via on-           person’s needs.
line support and self-help tools.
                                                       Education placements
Domestic abuse services                                Alternative education placements can vary
Tackling domestic abuse continues to be a              from academic placements with colleges
key priority for the Council and the broader           to vocational placements encouraging a
Safe Durham Partnership. Domestic abuse                more ‘hands on approach’ or therapeutic
can seriously harm children and young people           placements like counselling or developing
whether they are abused directly by the                confidence and social skills.
perpetrators and by hearing, witnessing or
intervening in incidents. Witnessing domestic          We have high expectations for all young
abuse is child abuse, and teenagers can suffer         people who live in County Durham. We want
domestic abuse in their relationships.                 to ensure that they have access to appropriate
                                                       education, in a safe learning environment
The council commission a countywide                    and are given the opportunity to gain and
Domestic Abuse Service. The service delivery           develop skills to help them progress, learn
model places a significant emphasis upon               and develop. To support the development of
integration with social care teams and seeks           high quality alternative education the Council
to provide:                                            manages a directory of alternative education
                                                       providers for schools to access when
•		Individual practical and emotional support          considering placing a pupil on an alternative
   to victims of domestic abuse aged 16 years          provision. This directory provides schools with
   and over in a variety of formats to meet the        information on those providers who have been
   needs of the victim including face to face          quality checked and monitored to make sure
   1:1 sessions or over the telephone;                 they meet minimum standards.
•		Individual support to children and young            Businesses or organisations that become
   people aged up to 17 years who witness              providers of alternative education and offer
   domestic abuse in a range of settings               placements will receive funding from schools
   including group work and 1:1, meeting the           for each student placed. If you want to make
   needs of the individual.                            a difference and become a recommended
These services are scheduled to be                     provider of alternative education in County
recommissioned in autumn 2018. Going                   Durham you will need to register your interest.
forward it is anticipated that there will be           Completion of the Alternative Education
further emphasis placed on the integration             Directory application form and Provider self-
of domestic abuse services to improve the              assessment form available at www.durham.
health, wellbeing and safety of victims who  
have experienced domestic abuse and the
                                             Market We have a commitment to supporting
safety of children who have witnessed Opportunitiesproviders and will provide training
domestic abuse; whilst challenging and              opportunities which can be accessed by

alternative providers to support workforce and         value for money’ and positive outcomes for
organisational awareness and development.              children and young people enabling them to
                                                       live independent, safe and active lives.
Achieve the best possible outcomes for
children and young people with special                 These services are scheduled to be
educational needs and disabilities (SEND).             recommissioned in autumn 2018.
In County Durham, we want all children                 Providers providing personal care at any
and young people (0-25 years) with special             time must be registered with the Care
educational needs and/ or disabilities (SEND)          Quality Commission (CQC) for the provision
to be given every opportunity to take control          of Domiciliary Care Services. Services will be
of their lives, be as independent as possible          available twenty four hours per day, seven
and achieve their full potential in life.              days per week, and three hundred and
                                                       sixty five days per year, flexible, timely and
SEND services                                          speedily accessed. They may be required in
We will focus attention on services which              an emergency situation with 24 hours’ notice
prevent, delay or reduce needs from                    or for a brief period of time; in addition to
escalating, working alongside our families to          requirements for long-term care to service
focus on maximising inclusion, confidence and          users within their own homes to prevent
independence. This will require a co-ordinated,        unnecessary admission to hospital or
personalised, creative and flexible approach to        children’s residential care facilities.
providing services.
                                                       For further information contact:
Going forward the council and the CCGs will be
seeking to build upon the recent reviews of:           Strategic leads for commissioning within Adult
                                                       and Health Services and Children and Young
•		Paediatric Therapy Services                         People’s Services are shown below:
•		Autism (including Social Communication              •		Neil Jarvis – Interim Strategic
   Assessments)                                           Commissioning Manager Older People /
•		High Needs Educational Provision                       Physical Disability and Sensory Impairment
To inform the recommissioning of services                 Services
education, health and care services.                   •		Tricia Reed – Interim Strategic
                                                          Commissioning Manager Learning Disability
                                                          and Mental Health Services
                                                       •		Mark Smith – Strategic Commissioning
                                                          Manager Children and Young People’s
                                                          Services and Public Health

Children’s domiciliary care services
Enable children and young people to live
within their own home and community while
preserving maximum independence and
quality of life. The Council is committed to
the delivery of high quality Domiciliary Care
Services and wishes to work in partnership Market Contact strategic commissioning managers
with providers, who can demonstrate and Opportunities on or
deliver services which achieve and maintain           by telephone on 03000 266 837

9. Key Messages from Public Health
 Durham County Council aims to improve                                                    Every child to have the best start in life
 and protect the health of local people and                                               Give our children the best start in life by
 reduce the unacceptable differences in                                                   commissioning high quality 0-5 health visiting
 health inequalities that continue to exist.                                              services, reducing smoking in pregnancy
                                                                                          and childhood obesity, and by improving
Combining the needs identified in the                                                     breastfeeding and emotional health &
Joint Strategic Needs Assessment; the                                                     wellbeing.
requirements of the mandated services for
local government; the data provided via                                                   Excellent drug and alcohol provision
the local Health Profiles; as well as local                                               •		Reduce the harm from alcohol.
knowledge about services and assets in our
communities; means that in order to achieve                                               Mental health at scale
the Public Health Vision, we need to focus on                                             •		Support the County Durham Partnership
the following key areas:                                                                     Prevention at scale – mental health.
Good jobs and places to live, learn and play                                              •		Improve mental wellbeing for all ages
•		Develop opportunities for good                                                            including suicide prevention and reducing
   employment                                                                                loneliness.
•		Reduce poverty
                                                                                          Our healthy workforce
•		Encourage inclusive growth, employment,                                                •		Develop the wider public health workforce
   education and skills                                                                      via Making Every Contact Count (MECC).
•		Ensure good homes for everyone
                                                                                          Better quality of life through integrated
•		Develop a community led approach and                                                   health and care services
   help to build connected and resilient                                                  •		Reduce the morbidity and improve quality
   communities.                                                                              of life for those with long term conditions
                                                                                             including cancer, CardioVascular Disease
                                                                                             (CVD) and respiratory conditions.
                                 Every child to
                                 have the best
                                  start in life                                           Positive behaviour change – smoking,
   Good jobs and
                                                               Mental health              activity and food
   places to live,
   learn and play
                                                                 at scale                 •		Work towards a smoke free future for our
                                                                                             children and families.
                                                                                          •		Carry out dedicated interventions with
                                                                                             targeted populations including Gypsy
    High quality                                                     Promoting               Roma Travellers (GRT), those most at risk of
  drug and alcohol
                                                                                             domestic abuse, drug & alcohol misuse and
                                                                                             sexual health.
                                                                                          •		Tackling obesity (sedentary behaviour and
                                                                                             poor food consumption).
                                                   Better quality
                                                   of life through
                                                  health and care


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